Rabies (cont.)

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Should people get a preexposure vaccination before traveling outside the U.S.?

The CDC suggests people consider preexposure vaccination for rabies if planned activity will bring you into contact with wild or domestic animals, for example if

  1. you are a biologist, veterinarian, or agriculture specialist working with animals;
  2. you will visit remote areas where medical care is difficult to obtain or may be delayed, for example, hiking through remote villages where dogs are common;
  3. your stay is longer than one month in an area where dog rabies is common. The longer your stay, the greater the chance of an encounter with an animal.
Preexposure vaccination consists of the treatment schedule presented in the prevention section of the article, except that the rabies immune globulin shot in not given.

What is the prognosis for people with rabies?

People who are treated early and appropriately when exposed to rabies have an excellent prognosis. As stated previously, no one who has begun this treatment within 48 hours of exposure and has followed it appropriately has ever developed a fatal case of rabies in the U.S. Some individuals with a debilitated immune system (for example, HIV or cancer patients) may require additional treatment and monitoring. An infectious-disease consultant should be consulted to optimize treatment and prognosis. Although some investigators report some treatment success in patients treated beyond 48 hours, the longer the delay in treatment, the more likely the person will develop a fatal infection due to rabies virus.

Unfortunately, untreated or inappropriately treated rabies is almost always fatal. Although heroic efforts have been attempted to save patients, success is very rare. Death usually occurs in about seven days from respiratory failure after the more severe rabies symptoms develop.

REFERENCES:

Manning, S., C. Rupprecht, D. Fishbein, et al. "Human Rabies Prevention -- United States, 2008: Recommendations of the Advisory Committee on Immunization Practices." MMWR 57.RR-3 (2008): 1-28.

McGettigan, J. "Experimental Rabies Vaccines for Humans." Expert Rev. Vaccines 9.10 (2010): 1177-1186.

United States. Centers for Disease Control and Prevention. "Imported Human Rabies -- New Jersey, 2011." MMWR 60.51 Jan. 6, 2012: 1734-1736. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6051a2.htm>.

United States. Centers for Disease Control and Prevention. "Rabies." Dec. 6, 2011. <http://www.cdc.gov/rabies/>.

United States. Centers for Disease Control and Prevention. "Rabies Around the World." Apr. 22, 2011. <http://www.cdc.gov/rabies/location/world/index.html>.

United States. Centers for Disease Control and Prevention. "Rabies Prevention." Apr. 22, 2011. <http://www.cdc.gov/rabies/prevention/index.html>.

United States. Centers for Disease Control and Prevention. "Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies." MMWR 59(RR02) Mar. 19, 2010: 1-9. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm>.


Last Editorial Review: 4/18/2012


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Rabies - Symptoms Question: Did you or someone you know have rabies? What were the main symptoms and when did they appear?
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